Diastasis Recti: Abdominal Muscle Separation

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Dr. Atul Kesarwani, Medical Director and Board Certified Plastic Surgeon

A tummy tuck is the only plastic surgical procedure that involves repair of diastasis recti, a condition informally known as abdominal muscle separation. It is also known as rectus diastasis.

If you’ve had one or more children, your stomach most likely shows the effects of childbearing. Your stomach may bulge out.

You eat well, exercise and don’t have much fat as a result. Yet, you look like you’re still pregnant. You may have diastasis recti.

What is diastasis recti?

Diastasis recti is the name of a common condition that affects the ab muscles (rectus abdominis muscles). The rectus abdominis muscles are located in the mid-section, running vertically from the sternum down to the pubic bone as two sets of muscles. One set is on the left side of your abdomen and the other is on the right. These are joined together at the midline by connective tissue (linea alba) that is composed of collagen.

With pregnancy, your body has to accommodate to the increasing size of the growing fetus. Your stomach skin stretches, internal organs get pushed out of the way and the connective tissue binding your rectus abdominis together stretches, causing the left and right side of these muscles to separate from each other. After childbirth, it is very common for the linea alba to be so stretched out that it is unable to snap back together, much like an overstretched elastic band or plastic wrap, leaving the rectus abdominis muscles separated. This is what diastasis recti is. According to a study published in the Journal of the American Physical Therapy Association, women with diastasis recti can experience a separation at any location along the midline of the rectus abdominis, however the most common area was in the area of the belly button.

Other causes of diastasis recti include the following:

  • birth defect (the condition usually resolves itself in a few weeks)
  • massive weight loss and weight fluctuations (rectus abdominis muscles separate to accommodate the accumulation of internal fat)
  • aging (connective tissues generally weaken with age, making you more prone to development)
  • trauma, often from doing strength training exercises improperly

What problems diastasis recti can cause?

There are several issues that rectus abdominis separation can cause. They can be aesthetic or functional. Aesthetic problems can include:

  • undesirable bulging or ridging
  • looking pregnant when you actually aren’t
  • lack of a waist

Considering the dynamic stabilization the rectus abdominis provides, a multitude of functional problems can be caused by diastasis recti. These include:

  • lower back pain
  • constipation
  • hernia
  • pelvic floor dysfunctions
  • instability

Do I have diastasis recti?

A more accurate diagnosis can be obtained by seeing your doctor, however this may point you in the right direction:

Lie on your back and do a partial sit-up. With your back halfway off the floor, view or feel whether there is a vertical gap or dip right in the middle of your stomach. You may also notice a bulge. While a gap of over 2.5 cm in width is considered presence of diastasis recti (2.5 finger widths), the condition may still exist if it’s smaller.

In severe conditions, the gap or bulging is easily noticeable when the muscles aren’t contracted.

Ultrasonography is a diagnostic tool that doctors use.

If you’ve just had a child, it’s best to wait a couple of months before testing for diastasis recti. You should wait until after your incisions have closed and your body to recover from the experience of childbirth.

What makes it worse

Straining is probably the worst thing you can do if you have this condition. Any kind of physical strain, whether during exercise, play or even while on the toilet, can make it worse. This is because contraction of your rectus abdominis causes the left and right side of the muscles to push apart, stretching out the linea alba again. That means exercises that you think can correct the problem, like sit-ups, twists, planks and swimming, actually work against you.

How to fix diastasis recti

Once you develop diastasis recti, it can be very difficult to repair it without medical treatment, which may include surgery. If you’re lucky, it will go away on its own. More often than not, however, it is permanent when left untreated.

Abdominoplasty is a treatment option

Abdominoplasty, or a tummy tuck, is one of the popular procedures for postpartum women who are unhappy with the contour of their stomach. This surgery recontours the stomach to make it flatter and firmer by removing excess fat and skin, as well as corrects diastasis recti. Non absorbable sutures are used to bind the left and right side of the separated abdominal muscles together. In a study titled, Long-Term Follow-Up of Correction of Rectus Diastasis¬Ě, patients experienced no reoccurrence of rectus diastasis following their tummy tuck, proving that the surgery is effective as a treatment option.

Will just wearing a binder help?

Wearing a binder is not an effective treatment option for diastasis recti. The real problem is the stretched out connective tissue that is no longer keeping your ab muscles together. This connective tissue will not retract by wearing a binder. Therefore, a binder is really just covering up the problem without addressing the real issue.